California hires relatives of hospital reform effort's leader

The reforms plan's core approach to treatment was group classes

Robert Gauthier / Los Angeles Times

The reforms plan's core approach to treatment was group classes, like these at Metropolitan, on such topics as anger management. The classes largely replaced individual therapy, which clinicians say patients need in order to understand their illnesses and show progress.

The reforms plan's core approach to treatment was group classes, like these at Metropolitan, on such topics as anger management. The classes largely replaced individual therapy, which clinicians say patients need in order to understand their illnesses and show progress. (Robert Gauthier / Los Angeles Times)

During Nirbhay Singh's eight years as lead consultant for California's psychiatric hospitals, state officials hired his relatives, then urged the facilities to use a little-known therapy and psychological questionnaire they had devised, state records and interviews show.

To fill out Singh's consulting team, the Department of Mental Health in 2006 hired his wife, Judy Singh, whose background is in reading comprehension and adult literacy. Over 41/2 years, she earned more than $340,000, primarily training staff members in a therapy she helped develop, state records show.

In "narrative restructuring therapy," or NRT, patients were encouraged to positively recast their life stories so they would be motivated to attend treatment. The most highly trained therapists largely refused to use the method because of concerns that it was untested on the severely ill.

"We tried to stay away from it," said Dae Peter Lee, a psychologist at Metropolitan State Hospital in Norwalk.

Cindy Radavsky, until recently in charge of the state's public mental hospitals, said the therapy had "pretty good results." Asked for evidence, the department provided data showing that four patients had attended more treatment classes. A state spokeswoman said the hospitals stopped using NRT last year after "it was determined that the program was not effective compared to the clinical resources required."

Judy Singh said that her role in developing NRT was limited to writing the training manual and that her expertise is in "staff training." Records show she billed for hundreds of hours spent analyzing transcripts of patient sessions, often from her home in Virginia.

Also hired for Singh's consulting team was Angela Adkins, who trained psychologists in behavioral treatments. She calls Nirbhay Singh her mentor, published research with him and taught meditation through a nonprofit he started. In 2010, she married his son.

State hospital psychologists complained that Angela Adkins Singh, who had a bachelor's degree in psychology, lacked the credentials to instruct professionals with doctorates. She said her consulting work was in "systems reform" and did not require a PhD. She earned more than $420,000 between 2004 and 2010.

In 2006, Singh's son, Ashvind, then a doctoral student in psychology, applied for internships in state hospitals. He was not chosen at Napa, Atascadero, Patton or Metropolitan, according to sources familiar with the selection process who spoke on condition of anonymity.

Metropolitan's executive director at the time, Sharon Smith Nevins, then added an internship slot and the hospital chose him to fill it.

Fourteen months after earning his doctorate, the younger Singh was placed in charge of Metropolitan's compliance with the reform plan. He now earns $107,160 annually.

After his arrival, the hospitals adopted a questionnaire he helped develop to assess patient behavior. In an email to department officials, Atascadero's psychology chief Diane Imrem said Nirbhay Singh "instructed" psychologists to use the questionnaire. And Jim Jones, then Napa's psychology chief, said, "It was forced on us, down our throats."

Nirbhay Singh said he did not tell clinicians they had to use the questionnaire, and Radavsky said it was one of several options. It is rarely if ever used in state hospitals now.

Singh's son did not respond to requests for comment.

Radavsky said the younger Singh, Angela Adkins Singh and Judy Singh were hired on their merits.

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